Primary care experiences in the ‘Let’s test for HPV’ study: a qualitative analysis
Kayden Borchowsky 1 , Morgan Rush 2 , Thomas Mullally 3 , Lynn McBain 1 , Ben Hudson
3 , John McMenamin 2 , Debra Smith 2 , Peter Sykes 4 , Susan Garrett 1 *
1 Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
2 Health and Research Collaborative, Wicksteed Street, Whanganui, New Zealand.
3 Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand.
4 Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand.
Journal of Primary Health Care 15(2) 147-154 https://doi.org/10.1071/HC23038
Published: 27 June 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: The National Cervical Screening Programme (NCSP) will switch from cervical cytology to Human Papillomavirus (HPV) testing as the primary cervical screening modality in 2023. To prepare for rollout an implementation study of HPV testing in primary care commenced in August 2022 in three different geographic regions in NZ.
Aims: This study explores Primary Care Staff’s experience of using the HPV testing pathway in the ‘Let’s test for HPV’ study so that recommendations can be made to improve the testing process before nationwide roll-out.
Method: Thirty-nine primary care staff were interviewed across all 17 practices in the Capital and Coast, Canterbury and Whanganui region participating in the ‘Let’s Test For HPV’ study. In total 19 interviews took place which followed a semi-structured approach. These interviews were recorded and transcribed. Template analysis was carried out on transcripts to aid in identifying themes.
Results: Three key themes, with additional subthemes, were identified. Staff were strongly supportive of the new testing regime. Interviewees identified some issues with the new pathway. Educational needs for both patients and clinicians were identified.
Conclusion: Primary care staff described the experience of using the HPV testing pathway positively; however, there were requests for ongoing additional support and nationwide rollout to be supported by practitioner and patient education programmes. With the right support this new pathway for cervical cancer screening has the potential to improve access for previously underserved and unserved groups.
Keywords: cervical cancer, cervical screening, health services research, HPV, human papillomavirus, self‐sampling, self‐testing, primary care.
References
[1] World Health Organisation. Eliminating Cervical Cancer. World Health Organisation; 2022. Available at https://www.who.int/health-topics/cervical-cancer#tab=tab_2 [cited 15 November 2022].[2] Ministry of Health. National Cervical Screening Programme Annual Report. Ministry of Health; 2017. Available at https://www.nsu.govt.nz/system/files/page/national-cervical-screening-programme-annual-report-2017-oct20.pdf [cited 15 November 2022].
[3] Hider P, Dempster-Rivett K, Williman J, et al. A review of cervical cancer occurrences in New Zealand 2008–2012. N Z Med J 2018; 131 53–63. Available at https://pubmed.ncbi.nlm.nih.gov/29565936/
[4] WHO. Cervical Cancer. World Health Organization; 2022. Available at https://www.who.int/news-room/fact-sheets/detail/cervical-cancer [cited 9 January 2023].
[5] Koliopoulos G, Nyaga VN, Santesso N, et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev 2017; 2018 CD008587
| Cytology versus HPV testing for cervical cancer screening in the general population.Crossref | GoogleScholarGoogle Scholar |
[6] Tranberg M, Bech BH, Blaakær J, et al. Preventing cervical cancer using HPV self-sampling: direct mailing of test-kits increases screening participation more than timely opt-in procedures - a randomized controlled trial. BMC Cancer 2018; 18 273
| Preventing cervical cancer using HPV self-sampling: direct mailing of test-kits increases screening participation more than timely opt-in procedures - a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
[7] Nelson EJ, Maynard BR, Loux T, et al. The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis. Sex Transm Infect. 2017; 93 56–61.
| The acceptability of self-sampled screening for HPV DNA: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[8] Adcock A, Cram F, Lawton B, et al. Acceptability of self‐taken vaginal HPV sample for cervical screening among an under‐screened Indigenous population. Aust N Z J Obstet Gynaecol 2019; 59 301–7.
| Acceptability of self‐taken vaginal HPV sample for cervical screening among an under‐screened Indigenous population.Crossref | GoogleScholarGoogle Scholar |
[9] Brewer N, Bartholomew K, Grant J, et al. Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand. Lancet Reg Health West Pac 2021; 16 100265
| Acceptability of human papillomavirus (HPV) self-sampling among never- and under-screened Indigenous and other minority women: a randomised three-arm community trial in Aotearoa New Zealand.Crossref | GoogleScholarGoogle Scholar |
[10] MacDonald EJ, Geller S, Sibanda N, et al. Reaching under‐screened/never‐screened indigenous peoples with human papilloma virus self‐testing: a community‐based cluster randomised controlled trial. Aust N Z J Obstet Gynaecol 2021; 61 135–41.
| Reaching under‐screened/never‐screened indigenous peoples with human papilloma virus self‐testing: a community‐based cluster randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[11] Arbyn M, Smith SB, Temin S, et al. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ 2018; 363 k4823
| Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses.Crossref | GoogleScholarGoogle Scholar |
[12] King N. Template analysis. In: Symon G, Cassell C, editors. Qualitative methods and analysis in organizational research: A practical guide. Sage Publications Ltd; 1998. pp. 118–34.
[13] Brooks J, McCluskey S, Turley E, et al. The utility of template analysis in qualitative psychology research. Qual Res Psychol 2015; 12 202–22.
| The utility of template analysis in qualitative psychology research.Crossref | GoogleScholarGoogle Scholar |
[14] Brewer N, Pearce N, Jeffreys M, et al. Does screening history explain the ethnic differences in stage at diagnosis of cervical cancer in New Zealand? Int J Epidemiol 2010; 39 156–65.
| Does screening history explain the ethnic differences in stage at diagnosis of cervical cancer in New Zealand?Crossref | GoogleScholarGoogle Scholar |
[15] Carroll R, Tan KKH, Ker A, et al. Uptake, experiences and barriers to cervical screening for trans and non-binary people in Aotearoa New Zealand. Aust N Z J Obstet Gynaecol 2023;
| Uptake, experiences and barriers to cervical screening for trans and non-binary people in Aotearoa New Zealand.Crossref | GoogleScholarGoogle Scholar |
[16] Ministry of Health. Report of the Parliamentary Review Committee Regarding the National Cervical Screening Programme, April 2019. Wellington: Ministry of Health; 2019.
[17] Bartholomew K, Grant J, Maxwell A, et al. Feasibility and acceptability of telehealth and contactless delivery of human papillomavirus (HPV) self-testing for cervical screening with Māori and Pacific women in a COVID-19 outbreak in Aotearoa New Zealand. N Z Med J 2021; 135 83–94. Available at https://pubmed.ncbi.nlm.nih.gov/36356272/
[18] Bartholomew K, Lawton B, Sherman S, et al. Recommendations for implementing HPV self-testing in Aotearoa. N Z Med J 2021; 134 11–6.
